Medicaid Managed Care Procurement Cycles and Dually Eligible Special Needs Plans

Welcome to the third post in The Intersection’s series on Illinois transition to Medicare Dually Eligible Special Needs Plan (D-SNP) beginning January 2026. The Intersection is an advocacy blog that provides a space for delving into policy discussions on the intersection of affordability and accessibility of health care for older adults and adults with disabilities.  Readers of this blog can expect to access resources and information on future changes to healthcare programs as they are being determined. Today’s post will focus on Medicaid Managed Care Procurement and how it can affect D-SNPs.  

WHAT IS MEDICIAD MANAGED CARE PROCUREMENT?

States that have Medicaid Managed Care (MMC) have contracts with health insurance companies, Medicaid Managed Care Organizations (MCOs), to provide coverage for Medicaid enrollees. Medicaid Managed Care (MMC) Procurement is a process where states choose which MCOs can operate in their state.  After the Center of Medicare and Medicaid Services (CMS) reviews the contract to ensure it meets federal requirements, states exert complete control over how they administer and award contracts to MCOs.  The timeline of the procurement process can take roughly 18- 24 months to complete. The timeline includes:  

• States taking the time to plan for the release of the proposal  

• Time for MCOs to submit applications and for states to decide who is awarded the contract.  

• Time to ensure that MCOs are ready to implement coverage of benefits 

There are factors that could delay implementation such as an “awards protest,” which is when companies who are not awarded the contract protest the decision being made. Once a state’s current contracts end, the procurement cycle begins again. If an MCO would like to continue providing services, they will have to submit a new application.  

MMC PROCUREMENT AND ADVOCACY 

MCOs up for re-procurement are judged by how well they are performing on certain measures the state requires. During the procurement cycle, states can ask MCOs to submit their performance results. Some of the best practices that states can implement during MMC procurement are public engagement and transparency of the required contracts. Public input on the MCO contracts can build trust between the state and stakeholders. Additionally, engaging the stakeholders can lead to public buy-in to managed care policies and requirements. Stakeholder engagement is important due to how long the contracts are and how they affect both healthcare providers and enrollees. If there is not enough time in the procurement process before implementation, it can diminish opportunities for public engagement. Therefore, advocates should monitor the procurement cycle to ensure that MCO plans cover enrollee needs and that public engagement can happen.  

MMC PROCUREMENT AND D-SNPs

In 2026, Illinois will be only contracting with Exclusively Aligned D-SNPs. Exclusively Aligned D-SNPs are D-SNPs operated by a parent company that has a Medicaid Managed Care Plan in the same state.  

In terms of implementation, parent companies of both the MCO and the D-SNP have to go through two different procurement processes. If the procurement cycle for MCOs and the procurement cycle for D-SNPs are out of sync, it can delay implementation of the Exclusively Aligned D-SNP. Procurement cycles can be out of sync due to contract timing and whether any plans protest the award.  

The MMC procurement cycle can also affect the stability of an Exclusively Aligned D-SNP plan for the enrollee. When a MMC plan is not chosen for reprocurement, the Exclusively Aligned D-SNP they are associated with will not be viable for enrollees. Enrollees in that D-SNP would have to switch D-SNP, choose another Medicare Advantage plan, or go back to Original Medicare and not have integrated care.   

HOW TO TRACK MMC PROCUREMENT CYCLES IN ILLINOIS

Illinois publicly posts Managed Care Contracts on the Illinois Department of Healthcare and Family Services website. Avisery is on the lookout for when the D-SNP contract will be released and will be monitoring the timeline of Illinois MCO procurement cycle to understand if there is time for public engagement. Our interest in public engagement on the procurement process is to build trust within the program and to ensure that the policies serve all stakeholders, especially enrollees.  

by Stella Van Den Eeden, Avisery Training Specialist